Direct primary care - interesting

[ventana]

https://www.care4meclinics.com/

https://www.jsonline.com/story/communities/west/news/brookfield/2021/01/20/brookield-care-4-me-clinic-patients-pay-monthly-fee/4227213001/

Brookfield has a new direct primary care clinic, where patients are billed directly and pay a monthly membership fee

Evan Casey

Milwaukee Journal Sentinel

 

View Comments

 

Kajal Malkan worked as a physician assistant in urgent care for several years. But she quickly became exhausted and fed up after she was forced to see a required number of patients each day. 

So she decided to open Care4Me, a new direct primary care clinic at 280 Regency Court, Brookfield. 

Patients are billed directly, and they pay a monthly membership fee at the clinic.

No insurance? No problem. The prices are transparent and upfront, and there are no hidden fees, according to Malkan and Dr. John Krueger, the medical director at the facility. 

"It allows us to see a smaller patient panel and that way dedicate more time with them," Malkan explained. 

The clinic offers comprehensive primary care through clinic visits, telemedicine visits, lab testing, wellness coaching and more. Malkan also gives out her personal cell phone, so patients can contact her directly. 

"Our patients and members have no wait times. I give them same day or next day appointments," Malkan said. "If telemedicine works better, I utilize that option, because there are things that I can take care of through the telemedicine route." 

The clinic is part of a larger and growing trend called direct primary care, which has picked up steam across the nation in the last few years. It's focused on the idea that doctors and clinics no longer have to worry about lengthy insurance paperwork and instead focus more time on their patients, driving costs down. 

The idea is also based on communication with the patient so there are no hidden or unwanted fees. If the clinic does have to prescribe medication or do lab testing, they'll let the patient know the associated fees right away.

Malkan said they guarantee at least 45 minutes per visit. She also said she believes treatment is more affordable, because there are no complex or hidden charges. 

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The clinic has an adult plan, a child plan and wellness coaching. For adult and child primary care, patients pay $80 a month.

The clinic has no enrollment fee, but it does require a minimum of two months, "so patients can see the value," Malkan said. 

It also offers a one-time visit option as well, for nonmembers. 

So what does the clinic do?

It offers acute care, such as treating ear or sinus infections or bronchitis. It offers disease management and health screenings. It can also do in-office testing, for the flu or strep throat and other diseases. 

It also handles physicals and flu shots, and offers referrals to specialists for advanced care. 

And what about COVID-19? 

Malkan said if one of their patients tests positive for COVID-19, the clinic will schedule a daily check-in to monitor their symptoms and see whether there is a need to be evaluated for further care.

The clinic also offers COVID-19 testing as well.

Malkan said she's proud to be operating in Brookfield, where she grew up.

She said the direct primary care approach is a good option for many small businesses. 

"Our focus is providing affordable healthcare for individuals, families and small businesses," she added.

Learn more about the business at care4meclinics.com

Evan Casey can be reached at 414-403-4391 or evan.casey@jrn.com. Follow him on Twitter @ecaseymedia. 

 

[ventana]

Very interesting

 

By my take might have possibility.....

$80/month per person

Clinic needs about 15k/month bare minimum

That is 187 paying patients

If you have 250 patients - which seems manageable 20k/month - provider gets 10k, 10k for overhead

[turnedintoamartian]

Good for patients with the means. This covers no medicine, specialty visits, ER visits, diagnostics, or surgery so they still will need insurance. That combined cost is likely a burden for many. 

[ventana]

28 minutes ago, turnedintoamartian said:

Good for patients with the means. This covers no medicine, specialty visits, ER visits, diagnostics, or surgery so they still will need insurance. That combined cost is likely a burden for many. 

true, but it allows those willing to spend ($960/year-which by the way is LESS THEN most annual deductibles) to access routine care with convivence and ease......

[TheFatMan]

A friend of mine owns two of these. She is doing very well, and it is great for her patients. Very affordable - I think she mentioned she could get someone a brain MRI with and without contrast for like 200 bucks. CBC for 50 cents. A month of lasix for $1.50. 
She just recommends her patients have catastrophic health insurance in case. I believe she has deals worked out with specialists as well which makes those appointments more affordable.

[ventana]

1 hour ago, TheFatMan said:

A friend of mine owns two of these. She is doing very well, and it is great for her patients. Very affordable - I think she mentioned she could get someone a brain MRI with and without contrast for like 200 bucks. CBC for 50 cents. A month of lasix for $1.50. 
She just recommends her patients have catastrophic health insurance in case. I believe she has deals worked out with specialists as well which makes those appointments more affordable.

very interesting!!

 

who and where?  would love to talk with them.....

[TheFatMan]

12 minutes ago, ventana said:

very interesting!!

 

who and where?  would love to talk with them.....

PM sent!

[rev ronin]

When the patient and medical professional have no middlemen, it's amazing how cheap things can get for the patient, how profitable for the medical professional, and how satisfying for both.

[Cideous]

The problem with these clinics is when you need to refer patients on.  A lot will not have any insurance and when you have to send them out, the specialists won't take them.  You are now their established primary care so you are stuck with them.  I actually worked at a clinic that did something similar, and the referrals out were murder.

[ventana]

5 minutes ago, Cideous said:

The problem with these clinics is when you need to refer patients on.  A lot will not have any insurance and when you have to send them out, the specialists won't take them.  You are now their established primary care so you are stuck with them.  I actually worked at a clinic that did something similar, and the referrals out were murder.

I think the idea of having to have insurance is key

in my state something like 98% of people have insurance

 

I don't expect all the parts to be covered when the dishwasher repair guy shows up to my house ($120 trip fee!) and the costs go up.  Why does medicine have to be all inclusive??? 

 

[turnedintoamartian]

6 hours ago, ventana said:

I think the idea of having to have insurance is key

in my state something like 98% of people have insurance

 

I don't expect all the parts to be covered when the dishwasher repair guy shows up to my house ($120 trip fee!) and the costs go up.  Why does medicine have to be all inclusive??? 

 

I don’t like analogies between the human body and appliances so much. It’s too simplistic.

Healthcare systems are complex and involve trade offs. No simple answers!

DPC can be great but mostly for the healthy and well off. Patients with multiple comorbidities would really struggles with costs.

[ventana]

1 hour ago, turnedintoamartian said:

I don’t like analogies between the human body and appliances so much. It’s too simplistic.

Healthcare systems are complex and involve trade offs. No simple answers!

DPC can be great but mostly for the healthy and well off. Patients with multiple comorbidities would really struggles with costs.

I disagree

an unhealthy working class person with insurance with a 5000 ded could spent $80 a month and I would provide most if not all the care they need.  Instead of having to do all the insurance game(nightmare) they get to see me as often as they want, for $4000 LESS per year.    Granted if they end up using their insurance ie accident or major surgery, they (up to this point) are not getting credit for the monies spent on the DPC.  BUT (and this is a HUGE BUT)  The CARES act had some surprise billing info in it - in short it will likely change the way out of network is handled and they need to apply out of network cost to the deductible, negating the negative of a DPC practice..... in fact I wonder if they would be able to submit the $80 a month for reimbursement (if they were seen in that month)

 

It is highly complex and there is a lot of unwell people out there.  The fact that the dishwasher repair folks charge more then we do for trip visits says something about how broken out system is.....

 

[Rose66]

That is true as long as the pt is healthy very nice but when they need Specialist they are on their own, the Specialist are the ones who demand higher payments per service.

[rev ronin]

3 hours ago, Rose66 said:

That is true as long as the pt is healthy very nice but when they need Specialist they are on their own, the Specialist are the ones who demand higher payments per service.

So we can either...

1) Reform the most important part of the medical system, primary care, where EMR, Meaningful use, Internet portals, minimal appointment time, and the efficiency push has driven actually sane people to seek out NDs as if they could really be PCPs... knowing full well that's only a part of the solution, or

2) Do nothing.

I'm going with #1.  Having worked in primary care and outpatient specialties both, the power of referral incentivizes specialists to work with PCPs.  Even just ONLY doing #1 right creates a pool of patients with bargaining power.

Besides, healthcare cost sharing arrangements, combined with concierge care, already have this problem solved.  For a family of 5, I can have both for $7-8kish a year, minimal out of pocket, and cost sharing (not insurance, so not "coverage") up to a million dollars per incident.

[GetMeOuttaThisMess]

OK, I'll ask the "elephant in the room" question.  How is this any different from concierge medicine, or as in my case, utilization of a HDHP with an HSA?  For comparison sake, I saw my neurologist, cash pay using my HSA in early '20 (saving me from having to see a PCP for Neuro referral in what was in essence an HMO plan); and then again earlier this month using my negotiated HDHP/HSA and it was ~$120 last year compared to $70+ this year.  Either was a boatload cheaper than buying the traditional co-pay, non-HDHP and paying their monthly premium.  I, and my wife, really only need that catastrophic HCP for hospitalization and the remainder we can take care of OOP.

Edited February 2, 2021 by GetMeOuttaThisMess

[camoman1234]

Not a fan of DPC (concierge). They own you as they already paid you so you are at their beckon call 24/7. Lots of various reasons above that add to my point. 

[rev ronin]

6 hours ago, camoman1234 said:

Not a fan of DPC (concierge). They own you as they already paid you so you are at their beckon call 24/7. Lots of various reasons above that add to my point. 

Only if the provider is as bad at setting patient expectations as most new grads posting here seem to be in negotiating call pay.

[camoman1234]

16 hours ago, rev ronin said:

Only if the provider is as bad at setting patient expectations as most new grads posting here seem to be in negotiating call pay.

You can set expectations all you want with patients but when they own you they own you. It is called Concierge Primary Care for a reason. I have recently spoken with a few physicians that use to own and/or work for a Concierge practice and they said it was a nightmare. Just a N = 3, but have read others say the same thing. 

[rev ronin]

2 hours ago, camoman1234 said:

You can set expectations all you want with patients but when they own you they own you. It is called Concierge Primary Care for a reason. I have recently spoken with a few physicians that use to own and/or work for a Concierge practice and they said it was a nightmare. Just a N = 3, but have read others say the same thing. 

That's interesting, because I've not heard anything BUT good things from DPC clinicians. I wonder if the marketing is different enough to attract different sorts of patients?

[ventana]

22 hours ago, camoman1234 said:

You can set expectations all you want with patients but when they own you they own you. It is called Concierge Primary Care for a reason. I have recently spoken with a few physicians that use to own and/or work for a Concierge practice and they said it was a nightmare. Just a N = 3, but have read others say the same thing. 

Nope disagree.  No one owns my decision making practice but me.  The day I do something like this “ownership” you suggest is the day I retire.  
 

The expectation needs to be set that it is a medical practice not some sales practice.  Doing thus will result in some client loss but those are the patients that we can all afford to loose.  
 

 

[TheFatMan]

It would not be terribly difficult to have the patient sign a contract letting them know of the expectations and what behaviors would result in terminating your relationship. 

For my N=1 this has not been a problem. 

[TexasPA28]

I think this model could work for adults but not kids.  

For a pediatric DPC you need to get them vaccines, and the cost of the vaccines is outrageous.  Prevnar now costs over $200 per dose.  A standard 6 month old child vaccine series would cost upwards of $500.  I dont know very many patients willing to pay $500 for vaccines out of pocket on all the well checks.

Even if the patient has insurance that covers vaccines, a DPC office can't bill insurance for them because you are out of network.  And if you are in network with insurance, you can't give separate billing for a "membership fee" because that is against the insurance company contract.  So you either have to go all in on insurance or all out, there's no in between.

The other option is to force them go to the county health department for vaccines.  But you only qualify for VFC/free vaccines there if you have no insurance, or if you have insurance that doesn't cover vaccines.  If you go to the county health department and you have BCBS, they won't give you the vaccines and will force you to go to a primary care clinic, which won't be a DPC clinic because they don't accept insurance.  

 

 

[kettle]

Isn't this how insurance started? I've heard this is super common in other countries.....